Provider Demographics
NPI:1477735256
Name:VERMILYE, DIANE JEAN (RPH)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:JEAN
Last Name:VERMILYE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 MAPLELEAF DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2751
Mailing Address - Country:US
Mailing Address - Phone:716-688-1968
Mailing Address - Fax:
Practice Address - Street 1:1625 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14212-2042
Practice Address - Country:US
Practice Address - Phone:716-894-2443
Practice Address - Fax:716-892-6355
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36850183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist